Lawrence Payne 77 Public Service Scholarship Application

Commonwealth Honors College Room 301 University of Massachusetts, 157 Commonwealth Ave., Amherst, MA 01003- 9253 Phone 413.545.2483/ Fax413.577.2620 [email protected] www.honors.umass.edu

140 Hicks Way, Amherst, MA 01003-9272 Phone 413.545.2483/ Fax [email protected]

Lawrence Payne ’77 Public Service Scholarship Application

Eligibility: Senior Commonwealth Honors College Students in good standing.

Awards: One award of $500.00. The award will be announced in early April and the recipient will be invited to the Commonwealth Honors College spring awards ceremony in late April 2015. Awards are processed through the UMass Financial Aid Office and posted to student’s university account. Students must set themselves up with an Excess Express Account through the Bursar’s office. Any positive balances for seniors will be contained in the student’s Excess Express Account.

To Apply: Submit all application materials listed below to the Commonwealth Honors College Office, Room 301.  Complete and sign the attached application form. Forms should be completed electronically or typed. Forms may be obtained from the Commonwealth Honors College Office. The information provided may be used for a press release.  Attach documentation of university or community-based service performed while students at the University of Massachusetts Amherst that includes: The organization and location where the service occurred, a description of role(s) held and work performed, and duration of the service. Note that community service is defined as service for which candidates have not been paid.  Two letters of recommendation from the agencies or organizations with which the student performed community service.  Submit a typed, double-spaced essay of one to two pages discussing your educational and career goals and how a scholarship will help you reach your goals. Deadline: Friday, February 27, 2015, 5:00 PM to the Commonwealth Honors College office, Room 301, Amherst, MA 01003-9253.

This scholarship was endowed by the Class of 1977 in memory of a classmate who graduated with Departmental Honors in Political Science. Lawrence Payne died April 3, 1996, in the plane crash in Croatia with Secretary of Commerce Ron Brown.

Selection: Applications will be reviewed and recipient selected by a committee convened by the dean of the Commonwealth Honors College. Selection is based on a combination of financial need, academic achievement and demonstrated record of public service.

Lawrence Payne ’77 Public Service Scholarship Application Form revised 06/14 Office Use Only Date Received: Cum: Grad year:

Commonwealth Honors College Member of Honors in good standing? Yes No Room 301 University of Massachusetts, 157 Commonwealth Ave., Amherst, MA 01003-9253 Phone 413.545.2483/ Fax413.577.2620 [email protected] www.honors.umass.edu Lawrence Payne ’77 Public Service Scholarship Application Student ID Email Date of Birth (MM/DD/YY)

Name (last) (First) (Middle)

Local Address Line 1 Address Line2

City State Zip Phone

Home Address Line 1 Address Line2

City State Zip Phone

Residency (check one) US Citizen Resident Visa Number of semesters Completed at UMass: Expected Grad Date: UMass Major (1) CHC Departmental Honors UMass Major (2) CHC Departmental Honors UMass Minor GPA

Other University awards, prizes or recognitions:

Community and Public Service Activities (you need to append community service documentation and two letters of recommendation as listed on the cover sheet):

Are you employed during the school year? Yes No If yes, how many hours a week on average do you work? Employer’s name and address:

What amount did you personally contribute toward college expenses this year? $ Last academic year’s contribution? $ Did you receive financial aid for the current school year? Yes No Amount received in loans? $

I, , the applicant, hereby sign this form and state that all information supplied in conjunction with this application is correct and true.

Signature of applicant: ______Date:______

Lawrence Payne ’77 Public Service Scholarship Application Form revised 06/14